Early Intervention Therapy Services for Infants With or at Risk for Cerebral Palsy

Early Detection and Intervention for Children with High Risk of Cerebral Palsy: A Survey of Physical Therapists and Occupational Therapists in Brazil

AIMS

The purpose of this study was to assess the current clinical practice of physiotherapists and occupational therapists on early detection and early intervention for children with cerebral palsy (CP) in Brazil.

METHODS

This was a cross-sectional study. A purpose-developed electronic survey was disseminated across the country to physiotherapists and occupational therapists working with young children with or at risk of CP.

RESULTS

A total of 205 anonymous respondents were included. Most participants (64.4%) agree that the diagnosis of CP can be made before 6 months of age. General Movements Assessment (26.8%) and Hammersmith Infant Neurological Examination (37.1%) were used infrequently. Infants at risk for CP receive therapy twice a week or more by 58.5% of therapists, 93.2% identified parents' goals as the most important factor in customizing the early intervention program. The most frequent intervention strategies for this age group were active stimulation of the child (n = 182), family training (n = 161), strategies to optimize the environment (n = 143), and neurodevelopmental treatment/Bobath (n = 99).

CONCLUSIONS

Currently, pediatric physiotherapists and occupational therapists in Brazil do not fully incorporate best practice tools for early identification of children with CP, nor sufficient best evidence-based interventions.

Identifying Opportunities for Early Detection of Cerebral Palsy

This study aimed to evaluate assessment and referral practices for the early detection and diagnosis of children at risk for or with cerebral palsy (CP) by health care and education providers in Maryland and Delaware. A secondary aim was to identify barriers for using early detection tools and identify opportunities for change to support early diagnosis and improve care. Seventy-two participants answered ≥ 50% of the survey questions. Most were occupational or physical therapists (86%) working in early intervention (61%). Eighty-eight percent indicated awareness that CP can be diagnosed by 12 months. Though 86% stated they typically suspect a diagnosis of CP between 0 and 12 months, only 19% reported that their patients received a CP diagnosis < 12 months. The Developmental Assessment of Young Children (73%) and the Peabody Developmental Motor Scales-2 (59%) were used most. Many respondents indicated never using magnetic resonance imaging (70%), the General Movements Assessment (87%), or the Hammersmith Infant Neurological Exam (69%). Participants identified clinical signs and symptoms prompting a referral for the diagnostic assessment of CP, most commonly stiffness in legs (95%), excessive head lag (93%), and persistent fisting (92%). Policy and organizational change, clinician education, and training are needed to support the implementation of CP early detection guidelines.

Parents of children with disabilities' perceptions regarding the quality of interaction with Health professionals working in early intervention: A qualitative descriptive study

AIMS AND OBJECTIVES

The aim of this study is to explore the perceptions of parents of children with physical disabilities concerning the quality of their interaction with health professionals in early intervention programs.

BACKGROUND

Despite the consensus on the need for Patient and Family-Centered Care, there are still difficulties when executing such care. The quality of interaction among patients, families, and professionals is essential to facilitate the implementation of the programs.

DESIGN

A qualitative descriptive study with thematic analysis using a Modified Grounded Theory approach.

METHODS

Data were collected through seven focus groups with 28 parents of children with physical disabilities who were undergoing early intervention programs in three centres. The study followed the COREQ guidelines and checklist.

RESULTS

Two themes emerged from the experiences: 'exchange of information and education', which included all the activities, procedures, exercises and skills taught by the professionals to help parents care for their child; and 'interpersonal skills', which focused on the way the professional relates with the child and the parents. Several subthemes emerged within each theme.

CONCLUSIONS

This study identified which elements of the professional-parent interaction are considered by parents when evaluating the quality of their interaction with the health care provider of their children.

RELEVANCE TO CLINICAL PRACTICE

The results of this study bring to light certain behaviours and interactions that health professionals should consider in order to improve the perceptions of parents of children with disabilities regarding the quality of interaction in the context of early childhood intervention.

PATIENT OR PUBLIC CONTRIBUTION

Parents contributed to the data collected. Early intervention professionals were involved in participant checking to ensure the rigour of the study.

Implementing Parent Coaching in Hospital-Based Pediatric Occupational Therapy: A Multisite Quality Improvement Project

IMPORTANCE

Parent coaching (PC) is a best practice for young children with, or at high risk for, cerebral palsy (CP). Occupational therapy practitioners in outpatient settings encounter barriers to implementing PC.

OBJECTIVE

To increase the documented use of PC in outpatient occupational therapy visits for children younger than age 2 yr with, or at high risk for, CP from 0% to 80%.

DESIGN

Multicenter quality improvement (QI) initiative with a time-series design.

SETTING

Three pediatric tertiary-care institutions, each with multiple outpatient occupational therapy clinics.

PARTICIPANTS

Practitioners in the outpatient clinics and patients <2 yr old with, or at high risk for, cerebral palsy.

INTERVENTION

Plan-do-study-act cycles included interventions packaged as a toolkit: education sessions, quick references, electronic medical record (EMR) supports, and site-specific strategies.

OUTCOMES AND MEASURES

The primary outcome measure was the use of PC in outpatient sessions. Process measures included pre- and posteducation practitioner knowledge scores and an EMR checklist. Balancing measures (ensuring that changes do not cause problems in other areas) of parent satisfaction/experience and practitioner productivity were measured pre- and postintervention.

RESULTS

The primary outcome measure goal (80% documented use of PC in sessions) was attained in the seventh month of the study, sustained for 4 mo, and settled at 79.1% for the remaining 6 mo. Practitioner knowledge scores increased from 83.1% to 87.9% after initial education sessions, t[56] = 3.289, p = .001. Parent satisfaction/experience and practitioner productivity scores did not change.

CONCLUSIONS AND RELEVANCE

QI methodology can support PC implementation in pediatric outpatient practice. What This Article Adds: This multisite QI initiative shows that outpatient occupational therapy practitioners can implement PC as a best practice with the use of a toolkit. Results suggest that education alone does not result in changes to practitioner behavior and that QI methods can help when implementing best practices in a clinical setting.

Feasibility of Using Joystick-Operated Ride-on-Toys to Promote Upper Extremity Function in Children With Cerebral Palsy: A Pilot Study

PURPOSE

To evaluate the feasibility of implementation, acceptance, and perceived efficacy of a joystick-operated ride-on-toy intervention to promote upper extremity (UE) function in 3- to 14-year-old children with hemiplegic cerebral palsy.

METHODS

Exit questionnaires were collected from children, caregivers, and clinicians/camp staff following a 3-week ride-on-toy training program incorporated within a summer camp for children with hemiplegic cerebral palsy. Training encouraged children to use their affected UE to maneuver the ride-on-toy. Questionnaires included Likert scale and open-ended questions to assess enjoyment, acceptance, feasibility, and perceived efficacy of the training.

RESULTS

All stakeholder groups indicated that the training was enjoyable. Clinicians/staff and caregivers indicated that the training increased children's motivation to use their affected UE and reported perceived improvements in UE movement control and function following training.

CONCLUSIONS

Our promising preliminary findings call for future research to systematically assess the efficacy of ride-on-toys to promote UE control and function in children with hemiplegic cerebral palsy.Supplemental Digital Content 1 video abstract, available at: http://links.lww.com/PPT/A404.

Caregiver Coaching in Early Intervention: A Scoping Review

IMPORTANCE

Best practice guidelines and legal mandates have deemed parent engagement an essential component of early intervention (EI). Parent coaching is an intervention and a model of service delivery used in occupational therapy practice that is designed to integrate parents into the therapy session.

OBJECTIVE

To examine the current definitions of coaching and the ways in which U.S. occupational therapy practitioners are using coaching models in EI.

STUDY SELECTION AND DATA COLLECTION

We systematically searched 11 databases-CINAHL Complete, CINAHL with full text, Education Research Complete, ERIC, PsycARTICLES, PsycINFO, Teacher Reference Center, Academic Search Premier, Academic Search Complete, Socindex with full text, and Social Work Abstracts-for articles published from 2000 through 2020. A total of 178 articles were retrieved, and 60 underwent full-text review. The final review included 16 studies of varying designs in which occupational therapy was one of the interventions and in which various definitions of coaching and models were used.

FINDINGS

The concepts inherent in coaching models were consistent across studies. There was little emphasis on the efficacy of coaching models as related to goal attainment.

CONCLUSIONS AND RELEVANCE

Coaching is a viable intervention in EI. Studies are needed to assess the efficacy of the parent coaching model in achieving child and family outcomes and the training needed to provide the intervention appropriately. What This Article Adds: This scoping review explores existing research on coaching interventions and models used by occupational therapists in EI. Findings indicate that this is an area of opportunity because the model of parent coaching strongly aligns with the professional scope of occupational therapy practice.

Tool Use for Early Detection of Cerebral Palsy: A Survey of Spanish Pediatric Physical Therapists

PURPOSE

The purpose of this study was to assess the use of diagnostic assessment tools in pediatric physical therapy practice in Spain. Best practice recommendations indicate the timely use of key assessment tools to reduce the age of diagnosis of cerebral palsy (CP).

METHODS

Pediatric physical therapists currently working in Spain in early intervention were recruited through targeted physical therapy entities. They were invited to complete the purpose-developed electronic survey, consisting of 45 multiple-choice questions, with 5 thematic blocks.

RESULTS

Results from 140 anonymous respondents were analyzed. The average reported age when CP was suspected was 12.6 months. Most used the child's clinical history (88.1%), the Alberta Infant Motor Scale (41.3%), and Vojta Assessment Procedure (32.1%) to assess and detect CP. General Movements Assessment (25.7%) and Hammersmith Infant Neurological Examination (28.4%) were used infrequently.

CONCLUSIONS

Currently, pediatric physical therapists in Spain rely on clinical history and outdated tools to identify children with CP.Digital Abstract available at: http://links.lww.com/PPT/A361 (English).Digital Abstract available at: http://links.lww.com/PPT/A362 (Spanish).

Parents' Perspectives on the Application of Home Activities in Early Intervention

Aims: This study explored parents' successes, challenges, and recommendations in relation to the application of home activities in early intervention.Methods: An electronic survey was prepared with Qualtrics software and distributed to parents of children with motor delays. Three open-ended questions were included at the end of the survey. Participants were the child's primary caregiver or guardian and their child must be currently receiving early intervention services or have received early intervention services from a physical or an occupational therapist in the United States in the past 5 years. Two coders used content analysis to analyze parents' responses to open-ended questions.Results: A total of 252 participants responded to at least one of the open-ended questions that were included in the survey. Responses were grouped into codes and categories that lead to the emergence of four themes. The themes indicated parent-reported challenges, successes, and recommendations in relation to team collaboration, individualization of activities, developmental gains, and parental support.Conclusions: The results of this study suggest that more focus should be directed toward parent-therapist partnership, multidisciplinary collaboration, and personalization of activities in early intervention. Parents-reported experiences and recommendation could assist early intervention personnel in advancing services provided for children with motor delays.

Collaborative Goal-Setting Beliefs and Practices of Out-Patient Pediatric Physical Therapists Working in Saudi Arabia and the United States

AIMS

(1) identify and compare family-centered care (FCC) and collaborative goal-setting (CGS) beliefs and practices of out-patient pediatric physical therapists (PTs) in Saudi Arabia (SA) and the United States (US); (2) describe CGS approaches; and (3) determine the association between CGS practices and educational level, clinical experience, and FCC beliefs and practices.

METHODS

87 PTs completed an online survey.

RESULTS

Ninety percent of PTs believed in FCC to a great extent. PTs in the US rated their organization's family-centeredness and their own FCC application significantly higher than PTs in SA. PTs believed in CGS with parents (86%) and children (66%) to a great extent while 69% of PTs reported applying CGS with parents to a great extent compared to 39% with children. PTs in SA rated the importance of determining therapy goals by PTs significantly higher than PTs in the US. The most selected CGS strategy was asking about concerns and needs. Low to moderate significant positive associations were found between CGS practices and PTs belief of their organization's family-centeredness and their own FCC application.

CONCLUSION

Similarities and differences were found between the two countries in FCC and CGS beliefs and practices. Organizational and individual FCC practices influence CGS practices.

Parental Adherence to Home Activities in Early Intervention for Young Children With Delayed Motor Development

OBJECTIVE

The purpose of this study was to investigate the relationship between characteristics of home activities and coaching practices with the adherence of parents of children with motor delays to home activities provided by physical therapists and occupational therapists in early intervention.

METHODS

An online survey study was developed and distributed to physical therapists and occupational therapists across the United States. A survey flier was posted online in parent support groups, physical and occupational therapy groups, newsletters, and organizations supporting parents of children with disabilities.

RESULTS

A total of 720 respondents participated in the survey, and 446 participants from 49 states met the inclusion criteria and were included in the analysis. Parents indicated that physical therapists and occupational therapists applied the 5 coaching practices (joint planning, observation, practice, reflection, and feedback). However, parents (63%) reported more time was needed on coaching. Parents stated that therapists' modeling the activities was the most helpful teaching technique that enhanced their adherence to home activities. Coaching practices, appropriateness of the home activities to daily routines and home environment, provision of home activities enjoyed by the child, and parent self-efficacy were all significantly associated with adherence to home activities.

CONCLUSIONS

Parents' adherence to home activities is affected not only by the type of coaching used by the therapists but also by the characteristics of the home activities provided for young children with delayed motor development.

IMPACT

The results of this study provide additional evidence supporting individualization of home activities to promote parents' continuous provision of learning opportunities to promote their children's development. There was also support of the therapists' use of the 5 coaching practices in early intervention to support the parent's application of home activities when the therapists are not present.

LAY SUMMARY

This study explored the use of home activities from the parents' perspective and provided valuable recommendations to therapists to improve parents' adherence to the recommended home activities in early intervention.

Challenges Faced by Therapists Providing Services for Infants With or at Risk for Cerebral Palsy

OBJECTIVE

The purpose of this study was to identify the challenges physical therapists (PTs) and occupational therapists (OTs) have in providing early intervention (EI) for infants with or at risk for cerebral palsy.

METHODS

Therapists' responses to an open-ended question were collected via survey that was distributed to EI providers and analyzed using content analysis.

RESULTS

The primary self-reported barriers to PT/OT EI services had 5 themes: (1) inadequate communication and collaboration, (2) challenges in coordination with family, (3) policy limitations, (4) meeting the child's individual medical needs, and (5) unequal access to resources.

CONCLUSION

Respondents reported that barriers are complex and exist at the individual, family, team, and societal levels. Further research is needed to explore barriers and solutions at each of these levels, from meeting a child's individual medical needs to improving interprofessional communication to increasing equitable access to resources.